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ALBERT EINSTEIN
905 many failures and disappointments, he longer much interested in didactic teaching. finally, after his greatest masterpiece, the Generalised in 1915 Above all (again in SINCLAIR’S words) " he knows published of Relativity-his theory of gravitation. what he is trying to do, and how he intends to set Theory In 1933 Einstein left Berlin as a result of the Hitler about doing it." His objective, if he is a preclinical teacher in any of the better schools, is not to impart purge ; and, after spending some months on the Continent, emigrated to the United States where he factual knowledge but rather to inculcate a scientific became a professor of physics at the Institute for method of thought and to stimulate the student to Advanced Studies in Princeton. There, up to the time use this so that he may learn for himself, and remain of his death, he was occupied in trying to develop a further able to learn for himself. Such an objective is attainextension of his theory which would embrace the electroable for a large proportion of students, but only if magnetic as well as the gravitational field. But though examinations are not exerting on them a diametrically he believed that he had obtained partial success, the
is
no
incentive. It is for this reason that in the best American schools examinations now play a very small part in the lives of students-a sharp contrast with the recent past. Such examinations as remain are intended principally to augment education rather than to assess knowledge; and they are no longer the main factor in deciding what the student tries to learn. Surely the time has come when we in this country should open our eyes both to the imperfections of our teaching and to possible means of removing them ?
complete solution always
eluded him. About 1940 he became an American citizen. It is often supposed that Einstein’s greatness lay in his mathematical ability. That was not so. Though he was, judged by the highest standards, a fine mathematician, there were others even in his own generation who were much greater. His surpassing brilliance was in the field of theoretical physics ; and his stupendous imagination and piercing insight enabled him to probe its foundations, to discover the flaws which were there, and to rebuild from the very bottom the whole structure To do this he had to employ the most complex anew. mathematical machinery ; but that machinery was not of his own making. It had been developed by othersAnnotations by Gauss, Minkowski, Riemann, Ricci, and Levi-Civita. It is remarkable that many of the fundamental conceptions he put forward during the development of ALBERT EINSTEIN his theories are essentially simple-so - simple that Einstein was one of the greatest scientists of all time. generations of thinkers had passed them by without Some would say that with Newton he stood above them appreciating their significance. The idea of the absolute all. simultaneity of separated events had passed unchallenged He was born in Ulm on March 14, 1879, of Jewish since the days of Newton. Yet Einstein saw that in parents. As a boy he does not seem to have made a terms of physically possible observations the idea was favourable impression on his teachers-probably because meaningless, and that the difficulty could be over-come of his dislike of the ordinary school discipline, his shyness, only by completely changing our ideas on space and and his great desire for privacy. But those who were time. This he did, and then went on to develop his nearer to him discovered his love of music and his Special Theory of Relativity. Again, at the outset of his promise of creative ability. It is said that at an early work on the Generalised Theory he was struck by the curious coincidence that the inertial mass and the age he learned almost unaided to solve simple algebraical problems, and that he discovered for himself a proof gravitational mass were always proportional to one of the theorem of Pythagoras. There is the story that, another. This fact, together with the similarity between when given a mariner’s compass at 5 years of age, he the effects of a gravitational field and those of an showed profound emotion and wonder at the sight of accelerated coordinate system, suggested to him that the needle pointing for no apparent reason always in there were strong a-priori reasons for supposing that an the same direction. One might almost suppose that at extension of his theory to include accelerated motions that moment there came to his childish mind some vague might be achieved if the manifestations of gravitation foreshadowing of his life’s great work-his abolition could be shown to arise out of the peculiar geometrical of the absolute attributes of space and time, and his creaproperties of space-time. Although in both these cases tion of a space-time geometry which, while it successfully a vast labour lay between the first idea and the developed embraced the phenomena of gravitation, never fully theory, the ultimate victory could scarcely have been succeeded in including those of electricity and magnetism. achieved without these flashes of inspiration, of which there were many more examples. From 17 to 21 Einstein was a student at the Zurich It has been said that if Einstein had never written a Polytechnic and a year later he became a Swiss citizen and obtained a quite humble job in the Swiss Patent word on Relativity he would still have been one of the Office at Berne. This gave him the leisure he required for foremost theoretical physicists of his generation : his developing his thoughts. In his first year at Berne he revolutionary contributions to the quantum theory in began to produce papers on theoretical physics, while its earlier phases would have sufficed to ensure that. in his third year, 1905, he published three papers which The greatest bugbear of modern science is its dual fairly shook the scientific world. One of these dealt with character. Microscopic physics has to be expressed in the Brownian movement manifested by microscopic terms of quantum theory, which depends on laws of particles as a result of molecular bombardment, and paved probability ; while macroscopic physics has to be the way for the only really direct proof of the existence expressed in terms of relativistic theory, which is governed of molecules. Another was concerned with the photoby the laws of causality. And the two theories appear electric effect and involved a completely revolutionary completely incompatible. Most scientists believe that advance in Planck’s quantum theory. The third was ultimately when the two become merged into one, the a 30-page paper giving the full development of his underlying theory will be of the probability type, while Special Theory of Relativity. As a result of these achieve- the relativistic theory for large-scale phenomena will ments, he held between 1909 and 1913 professorships in be found to be derivable from it statistically. Einstein Zurich and Prague ; and in 1914 he went to Berlin as took the opposite view. He felt that the probabilities, professor of physics and director of the Kaiser Wilhelm uncertainties, and discontinuities of the quantum theory, Institute for Research. During these years he had been while providing a useful tool in the present incomplete state .of knowledge, was fundamentally on an extension of his and Special Theory ; working
opposed
unsatisfactory
906 and represented only a passing phase in science. He felt that the all-embracing theory would be found to be based on the laws of causality. And it was his belief that the first step towards this larger synthesis was a further extension of his Generalised Relativity which would embrace in a space-time geometry not only gravitation but electromagnetism. In spite of his retiring nature Einstein played a leading part in the general affairs of the world in which he lived. He was an outspoken and courageous pacifist, and during the first world war he was one of the few German intellectuals who refused to sign a manifesto in support of German militarism : instead he issued one of his own protesting against it. In later years he vigorously Hitler and Nazism and their anti-Jewish opposed activities ; and it was in support of his fellow Jews that he thrust aside his shyness and made the few public appearances of his career. SUCROSURIA ONCE sucrose is absorbed into the blood-stream it is not metabolised but excreted in the urine. But sucrose is not a reducing sugar and so will not be detected in the
urine by routine chemical examination. Reports of patients with sucrosuria are very rare. In 1939 Elmer et al.1 described a single patient and reviewed earlier reports. They concluded that there were two varieties of the condition in adults : in " endogenous " sucrosuria, which has been noted in patients with pancreatic disorder, the sucrosuria persists even though sucrose is absent from the diet ; and in exogenous " sucrosuria, as in their own patient, sucrose in the diet is either poorly converted to glucose and fructose in the intestine or is absorbed unsplit by the gut wall. "
Infants and small children are less tolerant of sucrose than adults, and Lahdensuu2 showed by tolerance tests that the intestinal absorption of sucrose, and hence sucrosuria, is increased by feeding sodium bicarbonate and lessened by feeding hydrochloric acid. In 1910 Reuss3 had noted that sucrosuria was common in infants who had had gastro-enteritis, and this he attributed to increased permeability of the intestinal wall. Obviously, therefore, the significance of sucrosuria in infants and young children must be carefully evaluated. Moncrieff and Wilkinson4 quote paper-chromatography observations by Woolf that not more than 30 mg. per 100 ml. of urine is found after meals in normal infants and children. Any considerable amount of sucrose in infants and children, therefore, is likely to mean an anomaly either of sucrose digestion or of intestinal permeability. Reiner and Weiner5 described a 7-month-old boy who had temporary sucrosuria during a febrile illness. At the age of 18 months the boy was mentally defective. Moncrieff and Wilkinson4 have recorded three cases-a girl of 30 months, a girl of 18 months, and a boy of 18 months-in which sucrosuria up to 150 mg. per 100 ml. was present on a normal diet. All three children were mentally defective and had hiatus hernia. These children excreted sucrose, lactose, fructose, and occasionally glucose in abnormal amounts when fed sucrose and lactose ; but sugar excretion was normal when they were given glucose, fructose, and lactose. Sucrose, with glucose and fructose, caused only a slight increase in glucose excretion. It appeared, then, that it was lactose and sucrose together in the diet,which caused the abnormal increase of urinary sugars. Moncrieff and Wilkinson believe that the anomaly is one of intestinal absorption, since there must be some splitting of sucrose to explain the appearance of glucose and 1.
Elmer, A. W., Krasowska, M., Ptaszak, 1939, 101, 596.
L.
Acta med. scand
2. Lahdensuu, S. Ann. Med. intern. Fenn. 1947, 36, 293. 3. Reuss, A. Wien. klin. Wschr. 1910, 23, 123. 4. Moncrieff, A., Wilkinson, R. H. Acta pœdiat., Stockh.
5.
1954, 43, suppl. no. 100, p. 495. Reiner, M., Weiner, S. B. Amer. J. Dis. Child. 1939, 57, 590.
fructose in the urine after a test dose of sucrose. They were unable to get any specimens of intestinal juice during life, but in one child a post-mortem specimen was found to split sucrose and lactose. The hiatus hernia, though perhaps part of the syndrome, cannot be the cause of the sucrosuria, for a number of children with such hernia were found to have normal sugar metabolism. Again, it is tempting to attribute the mental defect to the sucrose in the blood, but in the one child who died the brain showed a number of developmental abnormalities. This is an interesting new field of study, not only for its clinical significance, but for the light it may throw on sucrose tolerance in normal infants and children. AORTIC STENOSIS
SURGICAL treatment of aortic stenosis 12 has quickly followed the successful relief of pure pulmonary stenosis, but the indications for operation are not yet defined. Bergeron and his colleagues 3 have recently analysed 100 cases of aortic stenosis to see whether the severity of the lesion and its prognosis could be predicted from clinical findings alone. In all cases the diagnosis was confirmed at necropsy, and associated valvular lesions excluded, while three grades of stenosis-mild, moderate, and severe-were recognised from post-mortem measure. ments. Bergeron et al. conclude that assessment of the severity of the lesion from clinical findings is unreliable and difficult, for the severity did not necessarily match the signs except when they found the classical picture of systolic murmur and thrill, diminished second sound, and a small pulse, which almost always indicated severe stenosis. Conversely, severe stenosis could be present with a systolic murmur alone, which was sometimes apical rather than basal. In 11 cases, only 2 of which had mild stenosis, no murmur was heard at any time, which added to the difficulties in diagnosis ; this was not just a terminal event due to extremely low output, since 2 patients only were in failure. The second sound was unreliable as a guide to diagnosis or severity, but a pulse pressure of 30 mm. Hg or less usually indicated severe or moderate stenosis ; but severe stenosis was not ruled out by higher pressures. Many patients remain symptom-free throughout their life or for many years. On the other hand, the onset of auricular fibrillation, heart-failure, cardiac pain, or syncope were grave prognostic signs in Bergeron’s series; for 75% of those of those whose in whom fibrillation developed, and hearts failed, died within a year. If two or more of these manifestations coexisted the prognosis was much worse. But for most patients the outlook was good, and the mean age of death in the series was nearly 69. These findings agree with those in other series 4and emphasise the many points of similarity between pure aortic and pulmonary stenosis, particularly as regards the murmur and second sound, and the long survival without symptoms in many cases. This is not surprising since the two lesions are anatomically rather similar, and they both cause simple obstruction to the outflow from their respective ventricles. At present the reasons why a ventricle should suddenly fail after overcoming an extra load for so long are imperfectly understood, although
50%
inadequate blood-supply to the myocardium from associated coronary narrowing or the stenosis itself must be important factors. It is therefore impossible to judge when failure is imminent until symptoms have appeared. Campbell6 has pointed out that a considerably raised right ventricular pressure in pulmonary stenosis may be an indication of the need for operation, even in the absence Bailey, C. P., Bolton, H. E., Jamieson, W. L., Nichols, H. T. Circulation, 1954, 9, 22. 2. Logan, A., Turner, R. Lancet, 1954, i, 1091. 3. Bergeron, J., Abelmann, W. H., Vazquez-Milan, H., Ellis, L. B. Arch. intern. Med. 1954, 94, 911. 4. Kumpe, C. W., Bean, W. B. Medicine, 1948, 27, 139. 5. Lewes, D. Brit. med. J. 1951, i, 211. 6. Campbell, M. Brit. Heart J. 1954, 16, 273. 1.
is
no
incentive. It is for this reason that in the best American schools examinations now play a very small part in the lives of students-a sharp contrast with the recent past. Such examinations as remain are intended principally to augment education rather than to assess knowledge; and they are no longer the main factor in deciding what the student tries to learn. Surely the time has come when we in this country should open our eyes both to the imperfections of our teaching and to possible means of removing them ?
complete solution always
eluded him. About 1940 he became an American citizen. It is often supposed that Einstein’s greatness lay in his mathematical ability. That was not so. Though he was, judged by the highest standards, a fine mathematician, there were others even in his own generation who were much greater. His surpassing brilliance was in the field of theoretical physics ; and his stupendous imagination and piercing insight enabled him to probe its foundations, to discover the flaws which were there, and to rebuild from the very bottom the whole structure To do this he had to employ the most complex anew. mathematical machinery ; but that machinery was not of his own making. It had been developed by othersAnnotations by Gauss, Minkowski, Riemann, Ricci, and Levi-Civita. It is remarkable that many of the fundamental conceptions he put forward during the development of ALBERT EINSTEIN his theories are essentially simple-so - simple that Einstein was one of the greatest scientists of all time. generations of thinkers had passed them by without Some would say that with Newton he stood above them appreciating their significance. The idea of the absolute all. simultaneity of separated events had passed unchallenged He was born in Ulm on March 14, 1879, of Jewish since the days of Newton. Yet Einstein saw that in parents. As a boy he does not seem to have made a terms of physically possible observations the idea was favourable impression on his teachers-probably because meaningless, and that the difficulty could be over-come of his dislike of the ordinary school discipline, his shyness, only by completely changing our ideas on space and and his great desire for privacy. But those who were time. This he did, and then went on to develop his nearer to him discovered his love of music and his Special Theory of Relativity. Again, at the outset of his promise of creative ability. It is said that at an early work on the Generalised Theory he was struck by the curious coincidence that the inertial mass and the age he learned almost unaided to solve simple algebraical problems, and that he discovered for himself a proof gravitational mass were always proportional to one of the theorem of Pythagoras. There is the story that, another. This fact, together with the similarity between when given a mariner’s compass at 5 years of age, he the effects of a gravitational field and those of an showed profound emotion and wonder at the sight of accelerated coordinate system, suggested to him that the needle pointing for no apparent reason always in there were strong a-priori reasons for supposing that an the same direction. One might almost suppose that at extension of his theory to include accelerated motions that moment there came to his childish mind some vague might be achieved if the manifestations of gravitation foreshadowing of his life’s great work-his abolition could be shown to arise out of the peculiar geometrical of the absolute attributes of space and time, and his creaproperties of space-time. Although in both these cases tion of a space-time geometry which, while it successfully a vast labour lay between the first idea and the developed embraced the phenomena of gravitation, never fully theory, the ultimate victory could scarcely have been succeeded in including those of electricity and magnetism. achieved without these flashes of inspiration, of which there were many more examples. From 17 to 21 Einstein was a student at the Zurich It has been said that if Einstein had never written a Polytechnic and a year later he became a Swiss citizen and obtained a quite humble job in the Swiss Patent word on Relativity he would still have been one of the Office at Berne. This gave him the leisure he required for foremost theoretical physicists of his generation : his developing his thoughts. In his first year at Berne he revolutionary contributions to the quantum theory in began to produce papers on theoretical physics, while its earlier phases would have sufficed to ensure that. in his third year, 1905, he published three papers which The greatest bugbear of modern science is its dual fairly shook the scientific world. One of these dealt with character. Microscopic physics has to be expressed in the Brownian movement manifested by microscopic terms of quantum theory, which depends on laws of particles as a result of molecular bombardment, and paved probability ; while macroscopic physics has to be the way for the only really direct proof of the existence expressed in terms of relativistic theory, which is governed of molecules. Another was concerned with the photoby the laws of causality. And the two theories appear electric effect and involved a completely revolutionary completely incompatible. Most scientists believe that advance in Planck’s quantum theory. The third was ultimately when the two become merged into one, the a 30-page paper giving the full development of his underlying theory will be of the probability type, while Special Theory of Relativity. As a result of these achieve- the relativistic theory for large-scale phenomena will ments, he held between 1909 and 1913 professorships in be found to be derivable from it statistically. Einstein Zurich and Prague ; and in 1914 he went to Berlin as took the opposite view. He felt that the probabilities, professor of physics and director of the Kaiser Wilhelm uncertainties, and discontinuities of the quantum theory, Institute for Research. During these years he had been while providing a useful tool in the present incomplete state .of knowledge, was fundamentally on an extension of his and Special Theory ; working
opposed
unsatisfactory
906 and represented only a passing phase in science. He felt that the all-embracing theory would be found to be based on the laws of causality. And it was his belief that the first step towards this larger synthesis was a further extension of his Generalised Relativity which would embrace in a space-time geometry not only gravitation but electromagnetism. In spite of his retiring nature Einstein played a leading part in the general affairs of the world in which he lived. He was an outspoken and courageous pacifist, and during the first world war he was one of the few German intellectuals who refused to sign a manifesto in support of German militarism : instead he issued one of his own protesting against it. In later years he vigorously Hitler and Nazism and their anti-Jewish opposed activities ; and it was in support of his fellow Jews that he thrust aside his shyness and made the few public appearances of his career. SUCROSURIA ONCE sucrose is absorbed into the blood-stream it is not metabolised but excreted in the urine. But sucrose is not a reducing sugar and so will not be detected in the
urine by routine chemical examination. Reports of patients with sucrosuria are very rare. In 1939 Elmer et al.1 described a single patient and reviewed earlier reports. They concluded that there were two varieties of the condition in adults : in " endogenous " sucrosuria, which has been noted in patients with pancreatic disorder, the sucrosuria persists even though sucrose is absent from the diet ; and in exogenous " sucrosuria, as in their own patient, sucrose in the diet is either poorly converted to glucose and fructose in the intestine or is absorbed unsplit by the gut wall. "
Infants and small children are less tolerant of sucrose than adults, and Lahdensuu2 showed by tolerance tests that the intestinal absorption of sucrose, and hence sucrosuria, is increased by feeding sodium bicarbonate and lessened by feeding hydrochloric acid. In 1910 Reuss3 had noted that sucrosuria was common in infants who had had gastro-enteritis, and this he attributed to increased permeability of the intestinal wall. Obviously, therefore, the significance of sucrosuria in infants and young children must be carefully evaluated. Moncrieff and Wilkinson4 quote paper-chromatography observations by Woolf that not more than 30 mg. per 100 ml. of urine is found after meals in normal infants and children. Any considerable amount of sucrose in infants and children, therefore, is likely to mean an anomaly either of sucrose digestion or of intestinal permeability. Reiner and Weiner5 described a 7-month-old boy who had temporary sucrosuria during a febrile illness. At the age of 18 months the boy was mentally defective. Moncrieff and Wilkinson4 have recorded three cases-a girl of 30 months, a girl of 18 months, and a boy of 18 months-in which sucrosuria up to 150 mg. per 100 ml. was present on a normal diet. All three children were mentally defective and had hiatus hernia. These children excreted sucrose, lactose, fructose, and occasionally glucose in abnormal amounts when fed sucrose and lactose ; but sugar excretion was normal when they were given glucose, fructose, and lactose. Sucrose, with glucose and fructose, caused only a slight increase in glucose excretion. It appeared, then, that it was lactose and sucrose together in the diet,which caused the abnormal increase of urinary sugars. Moncrieff and Wilkinson believe that the anomaly is one of intestinal absorption, since there must be some splitting of sucrose to explain the appearance of glucose and 1.
Elmer, A. W., Krasowska, M., Ptaszak, 1939, 101, 596.
L.
Acta med. scand
2. Lahdensuu, S. Ann. Med. intern. Fenn. 1947, 36, 293. 3. Reuss, A. Wien. klin. Wschr. 1910, 23, 123. 4. Moncrieff, A., Wilkinson, R. H. Acta pœdiat., Stockh.
5.
1954, 43, suppl. no. 100, p. 495. Reiner, M., Weiner, S. B. Amer. J. Dis. Child. 1939, 57, 590.
fructose in the urine after a test dose of sucrose. They were unable to get any specimens of intestinal juice during life, but in one child a post-mortem specimen was found to split sucrose and lactose. The hiatus hernia, though perhaps part of the syndrome, cannot be the cause of the sucrosuria, for a number of children with such hernia were found to have normal sugar metabolism. Again, it is tempting to attribute the mental defect to the sucrose in the blood, but in the one child who died the brain showed a number of developmental abnormalities. This is an interesting new field of study, not only for its clinical significance, but for the light it may throw on sucrose tolerance in normal infants and children. AORTIC STENOSIS
SURGICAL treatment of aortic stenosis 12 has quickly followed the successful relief of pure pulmonary stenosis, but the indications for operation are not yet defined. Bergeron and his colleagues 3 have recently analysed 100 cases of aortic stenosis to see whether the severity of the lesion and its prognosis could be predicted from clinical findings alone. In all cases the diagnosis was confirmed at necropsy, and associated valvular lesions excluded, while three grades of stenosis-mild, moderate, and severe-were recognised from post-mortem measure. ments. Bergeron et al. conclude that assessment of the severity of the lesion from clinical findings is unreliable and difficult, for the severity did not necessarily match the signs except when they found the classical picture of systolic murmur and thrill, diminished second sound, and a small pulse, which almost always indicated severe stenosis. Conversely, severe stenosis could be present with a systolic murmur alone, which was sometimes apical rather than basal. In 11 cases, only 2 of which had mild stenosis, no murmur was heard at any time, which added to the difficulties in diagnosis ; this was not just a terminal event due to extremely low output, since 2 patients only were in failure. The second sound was unreliable as a guide to diagnosis or severity, but a pulse pressure of 30 mm. Hg or less usually indicated severe or moderate stenosis ; but severe stenosis was not ruled out by higher pressures. Many patients remain symptom-free throughout their life or for many years. On the other hand, the onset of auricular fibrillation, heart-failure, cardiac pain, or syncope were grave prognostic signs in Bergeron’s series; for 75% of those of those whose in whom fibrillation developed, and hearts failed, died within a year. If two or more of these manifestations coexisted the prognosis was much worse. But for most patients the outlook was good, and the mean age of death in the series was nearly 69. These findings agree with those in other series 4and emphasise the many points of similarity between pure aortic and pulmonary stenosis, particularly as regards the murmur and second sound, and the long survival without symptoms in many cases. This is not surprising since the two lesions are anatomically rather similar, and they both cause simple obstruction to the outflow from their respective ventricles. At present the reasons why a ventricle should suddenly fail after overcoming an extra load for so long are imperfectly understood, although
50%
inadequate blood-supply to the myocardium from associated coronary narrowing or the stenosis itself must be important factors. It is therefore impossible to judge when failure is imminent until symptoms have appeared. Campbell6 has pointed out that a considerably raised right ventricular pressure in pulmonary stenosis may be an indication of the need for operation, even in the absence Bailey, C. P., Bolton, H. E., Jamieson, W. L., Nichols, H. T. Circulation, 1954, 9, 22. 2. Logan, A., Turner, R. Lancet, 1954, i, 1091. 3. Bergeron, J., Abelmann, W. H., Vazquez-Milan, H., Ellis, L. B. Arch. intern. Med. 1954, 94, 911. 4. Kumpe, C. W., Bean, W. B. Medicine, 1948, 27, 139. 5. Lewes, D. Brit. med. J. 1951, i, 211. 6. Campbell, M. Brit. Heart J. 1954, 16, 273. 1.